Thank you for choosing our online service. We are an asynchronous telemedicine platform powered by Board-Certified licensed physicians at HealthSource Medical Associates, providing you easier access to healthcare. We strive to help bridge the gaps in healthcare while encouraging you to establish care or follow-up with your primary care provider. Please note, our policy has been updated to allow a maximum of 5 days of validated absence per 30 day period. 

Please note that any doctor's note request submitted after 10pm PST (1:00am EST) will be reviewed starting the next morning during business hours (starting at 6am PST).

Please click next to proceed.

For your doctor's note request, Dr. Aaron Sartin, MD or Dr. Sally Sartin, MD will be reviewing your request depending on which state you are currently in.

If your state is listed below, please click "next" to proceed.

If your state is not on the list below, then please click here to be routed to the correct form.

Thank you. Your Health is Important to Us.

Please be reminded this service is an asynchronous platform, which means there will be no appointments necessary. A Board Certified physician licensed in your state will review your request to determine if a doctor's note can be approved. This request form is also designed for patients who had to miss work or school due to having symptoms of a mild illness or condition. 

If you are currently experiencing severe symptoms, such as chest pain, severe shortness of breath, stroke like symptoms, severe abdominal pain, or severe low back pain with inability to walk, please proceed to the nearest Emergency Room. If you are having any active suicidal thoughts, please call 988, the Suicide and Crisis Lifeline. 

By proceeding, you are acknowleding you are not having any of these severe symptoms.

If there is any chance you could be pregnant, we recommend you seek in-person care for a doctor's note.

If your employer or school does not allow for telemedicine to be used for obtaining a doctor's excuse note, please be seen by a local in-person provider.

Thank you. We will need you to select your symptoms and medical condition in the next section. Please note, these will not be included in your doctor's note in order to adhere to HIPAA guidelines. 

Thank you. We will now need you to enter your personal information in the next section including your name, DOB, address, phone number, and email address.

We will also need you to take a selfie and a picture of your photo ID for identity verification.

The only personal information that will be included in your note will be your name and DOB.

We operate under strict HIPAA regulations. This means, all of the other personal identification information you provide us will be kept confidential and secure using the highest HIPAA compliant standards, and will not be shared unless you expressly grant consent.

The way your name, date of birth, and dates of absence/return appear below is how they will appear on the note. Please check to make sure all information is correct.

Name:  {ltstronggtfirstNameltstronggt} {ltstronggtlastNameltstronggt}

Date of Birth: {ltstronggtdateOf}

Dates of work/school absence: {ltstronggtfirstDay} to {ltstronggtlastDay}

Return: {ltstronggtonWhich}

If not correct, please go back and correct the information before proceeding. By clicking "next", you acknowledge the the information is correctly represented. 

Email Address Verification

We have been having issues with hotmail accounts. Please avoid the use hotmail email accounts if at all possible, thank you.

Dr. Sally Sartin, MD will be reviewing your doctor's note request. Dr. Sartin is board certified in Family Medicine with the following active state licenses: 

All States except MA, NJ, and NM

We will now need you to take a couple of photos now for identity verification.

Why do we need a selfie and photo ID?

• A selfie and photo ID match is essential for fraud prevention. It helps to insure that you are actually the person requesting the doctor's note and are authorized to use the payment method detailed on the next page.

If you prefer, feel free to cover the license or passport number for added privacy. However, please make sure the photo ID clearly shows your name and date of birth so it can be matched to the information you already provided. 

Your information will be kept confidential and secure using HIPAA compliant standards and will not be shared. Your privacy is our utmost concern.

Thank you for submitting all the information necessary for Dr. Sartin to review your note request.  

Please note that any doctor's note request submitted after 10pm PST (1:00am EST) will be reviewed starting the next morning during business hours (starting at 6am PST). 

Please be reminded, there are no refunds once you receive our note as a secure attachment in your email. If there are any errors with your note you may email us at contact@mydrsnote.com.

Before submitting your request, please check again to make sure all information you have entered is correct as seen below. 

Name: {ltstronggtfirstNameltstronggt} {ltstronggtlastNameltstronggt}

Date of Birth: {ltstronggtdateOf}

Dates of work/school absence: {ltstronggtfirstDay} to {ltstronggtlastDay}

Return: {ltstronggtonWhich}

If there are any errors with the information above, please go back in the form to correct. 

To obtain your authentic doctor's excuse note signed by one of our Board-certified licensed physicians, please proceed to the last page to submit your payment. We have partnered with Stripe to securely process your payment. Thank you.